Utility of echocardiogram in neutropenic patients with gram positive bacteremia – a retrospective study

Introduction: Hemato-oncology patients are vulnerable to bloodstream infections due to immunocompromised state and use of intravascular catheters. Data regarding risk of infective endocarditis (IE) among those with gram-positive bacteremia are limited. We aimed to evaluate the incidence of IE among neutropenic hemato-oncology patients and explore the yield of echocardiogram in this population. Methods: We conducted a single retrospective study of all hospitalized hemato-oncology neutropenic patients with gram-positive blood cultures between 2007 and 2021. Data regarding patients’ characteristics, blood cultures, and echocardiogram were collected. Results: The study included 241 patients, with 283 isolates. Coagulase-negative Staphylococcus (CONS) was the most commonly isolate found, followed by Streptococcus viridans. Transthoracic echocardiography (TTE) was performed in 45% of patients overall, of which 5.8% had additional transesophageal echocardiogram (TEE). Only a single case of IE was identified in a 47-year-old multiple myeloma patient with neutropenic fever, S. viridans bacteremia, and stroke caused by septic emboli. TTE and TEE failed to demonstrate valvular pathology consistent with IE. Conclusion: In our experience, the yield of echocardiogram in hemato-oncological neutropenic patients with bacteremia is extremely low, owing to reduced probability of IE in this population, and thus could be avoided in most cases.